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UK" ZIHIHxa
DEC 28 1992
6 f; R E 1274 �i . '
CPnit##
�.
CITY OF FEDERAL WAY �
BUILDING PERMIT APPLICATION
— Please Print
Vz-7
C t4 A L,'e_ Y LtJ
BOX 1 TENANT NAME:
OWNER SITE L CATION f/ +t•'
OWNER'S ADDRESS CITY-;iAl-ta&e& PHONE
DESCRIBE JOB t
THE PROPERTY IS OWNED Y: SINGL Rl PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME 9C Z?e QL) CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS .
EXPIRATION DATE
CITY. _-.. _ PHON
—OR—
HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON PHONE •- D o O
BOX 4 SEWER DISTRICT am%d u tdhV WATER DISTRICT AD�1_ W
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION —A Zee=
BOX 6 PROPERTY TAX ACCOUNT NUM H 2-
d
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existi g
1ST FLOOR183-O .J 2ND FLOOR
313FLOOR 'mi D/.•�lb- BASEMENT nMjr= DECK_ 0..0 1- GARAGE
BOX 8 SINGLE FAMILY
( ) NEW CONSTRUCTION
-
-MULTIFAMILY-(NO-OF-UNITS = )
( j EXISTING-S-T-RUCTURE -
( ) COMMERCIALANDUSTRIAL
TOTAL AREA OF PROPERTY
.SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO.. WATERCLOSETS
GAS PIPING, FEET _
$
BATHTUBS
SHOWERS
N0. FURNACE, ELE1. GAS
GAS HOT WATER HEAT
$
$ _
LAVATORIES
_ _ . CONVERSION BURNES
$ �.
_ SINKS
BOILER, SIZE BTU
$
DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
HEAT P40S, SIZE
$
LAUNDRY WASHER OUTLET
UNIT ATERS
$
URINALS
Al OGLING UNITS, SIZE
$
— DRINKING FOUNTAINS
0MMERCIAL HOOD
$
SUMIAS, SPRINKLER VAC M BREAKERS
OTHER
$
D€(AINS
$
OTHER ev-t
TOTAL FIXTURES
- $
TOTAL MECHANICAL FE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
_QpINERtAGENT: - _. DATE:_—
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